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A new survey shows that approximately one in six public health workers said they would not report to work during a pandemic emergency regardless of its severity. The willingness to respond could be increased by raising the workers’ levels of concern and confidence in their work, researchers said.

The survey findings, which were produced by researchers at the Johns Hopkins Bloomberg School of Public Health and published in the July 24 edition of the journal PLoS ONE, are a significant improvement over a 2005 study conducted by the same research team. In the 2005 survey, more than 40 percent of public health employees said they were unlikely to report to work during a pandemic emergency.

“Employee response is a critical component of preparedness planning, yet it is often overlooked. Our study is an attempt to understand the underlying factors that determine an employee’s willingness to respond in an emergency,” said lead author Daniel Barnett, M.D., MPH, assistant professor in the Department of Environmental Health Sciences at the Bloomberg School of Public Health. “Overall, 16 percent of the workers surveyed said they would not report regardless of the severity of the outbreak.”

The online survey was conducted among 1,835 public health workers in Minnesota, Ohio and West Virginia from November 2006 to December 2007. The survey analysis was based on the Extended Parallel Process Model (EPPM), which postulates that willingness to follow instructions in an emergency is based on an individual’s perception of a threat’s validity and belief that the actions taken can be feasibly accomplished and will have a positive impact on the threat.

Concern, Confidence

According to the survey, public health workers who were both “concerned” about the threat posed by a pandemic, and who were “confident” that they could fulfill their response roles and that their roles would have a meaningful impact on the situation, were 31 times more likely to respond to work in an emergency than those who perceived the threat low and had low levels of confidence. Workers whose perception of the threat was “low” but who strongly believed in the efficacy of their job were 18 times more likely to say they would respond compared to those in the “low threat/low efficacy” group.

“We found belief in the importance of one’s work was strongly associated with a willingness to report to work in an emergency. Our results could help preparedness planners to identify work force needs and develop strategies for improving worker response,” said co-author Ran Balicer, M.D., Ph.D., MPH, senior lecturer in the Epidemiology Department at the Ben-Gurion University of the Negev in Israel, and Joint Editor of the Israeli Ministry of Health Pandemic Preparedness Plan.

“This study is important in that it both documents the problem and points the way towards specific interventions – those that increase both concern and confidence – to increase willingness to respond,” added Jonathan Links, Ph.D., professor in the Bloomberg School’s Department of Environmental Health Sciences and director of the Public Health Preparedness Programs.

The research was funded by the Center for Disease and Control Centers (CDC) Centers for Public Health Preparedness program, and by CDC’s Preparedness and Emergency Response Research Centers program.